OIG: Connecticut MFCU Recovers $84 Million and 20 Convictions
- Last week, the Office of Inspector General (OIG) released the results of a comprehensive review of the Connecticut State Medicaid Fraud Control Unit (MFCU) between the fiscal years of 2010 and 2012.
The report found that over this three year period, the Connecticut Unit reported civil and criminal recoveries of nearly $84 million and 20 criminal convictions.
The review itself was conducted in October 2013 as part of OIG oversight. Data was compiled and analyzed from seven different sources, which include:
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Review of policies, procedures, and documentation related to the Unit’s operations, staffing and caseload
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Review of financial documentation
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Structured interviews with key stakeholders
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Survey of Unit staff
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Structured interviews with the Unit Director and supervisors
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Onsite review of case files
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Onsite observation of Unit operations.
During the time of the study, open cases dropped from 110 in 2010 to 44 cases in 2012, which could be attributed to understaffing from September 2011 to April 2012. Referrals also dropped from 89 to 38. The Unit closed 189 investigations, charged 21 individuals and obtained 20 convictions.
The Unit recovered money in three different ways – criminal, global cases and nonglobal civil recoveries. Global cases have far and away the highest total, with more than $70.5 million over three years. Nonglobal civil recoveries were responsible for more than $11.5 million and criminal recoveries brought in $1.5 million.
Instances of failed Federal regulations
Over the course of the review, there were several instances where the Connecticut State MFCU was not in accordance with the 12 MFCU performance standards needed for compliance with Federal grant requirements.
Effective case files – The Unit did not always keep effective case files including a lack of basic organization structure, missing documentation of relevant facts and information and in 14 percent of files, it was unclear if the Unit received a referral.
Policies and procedures – Sixteen percent of cases were not opened in a period of time consistent with Unit policy as more than 60 days had elapsed between referral and “preliminary investigation.” Of the cases opened after this time period, the median time was 83 days. It was also found that in 82 percent of Supervisory reviews, which should be conducted every three months, the case files lacked proper documentation.
Conviction information – The Unit is required to send OIG information within 30 days of sentencing, including charging documents, plea agreements and sentencing orders. Of the 19 convictions obtained during the review, 14 were lacking sufficient information.
Staff working on non-Unit matters – During the review, investigators worked on a case that should have been handed off to a different organization as it did not involve Medicaid.
Proper allocation costs – the Unit maintained proper fiscal control of its resources, but the Unit’s vehicle expenditures were not properly allocated.
The OIC recommended that the Connecticut Unit take steps to address these areas of concern, adhere to proper policies and improve overall communication between the organizations. The MFCU concurred with these recommendations.
